Temporal Disturbance Order Form

Name:________________________________________________
Street:________________________________________________
City:__________________________________________________
State:__________________________Zip Code:_______________
E-Mail:________________________________________________

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Send this page with a Check or Money Order for $5 (postage included) to:
Omniscience
c/o Andrew Martin
W3834 County Highway J
Sheboygan Falls, WI 53085


Please make checks out to Andrew Martin as we don't have a shared account
Thanks much for listening! 1